Developing a function impairment measure for children affected by political violence: A mixed methods approach in Indonesia

Wietse A. Tol, Ivan H. Komproe, Mark J.D. Jordans, Dessy Susanty, Joop T.V.M. De Jong

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objective. Practitioners in political violence-affected settings would benefit from rating scales that assess child function impairment in a reliable and valid manner when designing and evaluating interventions. We developed a procedure to construct child function impairment rating scales using resources available in low- and middle-income countries. Design. We applied a mixed methods approach. First, rapid ethnographic methods (brief participant observation, collection of diaries and a focus group with children) were used to select daily activities that best represented children's functioning. Second, rating scales based on these activities were examined for their psychometric properties. Construct validity was assessed through a confirmatory factor analysis procedure. Setting. Central Sulawesi, Indonesia. Participants. Qualitative data were collected for 53 children and psychometric testing was done with 403 children [average age: 9.9 (SD = 1.21), 49% girls] and 385 parents. Results. Using locally available resources, we developed separate child-rated and parent-rated scales, both containing 11 items. The child-rated scale evidenced good internal, test-retest and inter-rater reliability and acceptable convergent and discriminant validity. Construct validity was confirmed by fit of the theorized factor structure-a social-ecological clustering of daily activities. Conclusions. The procedure resulted in a reliable and valid rating scale to assess child function impairment in the context of political violence. Practitioners can apply this procedure to develop new locally adequate rating scales to strengthen epidemiological surveys, baseline assessments, monitoring and evaluation and eventually, interventions. Further research should address the importance of gender differences and criterion-related validity.

Original languageEnglish (US)
Article numbermzr032
Pages (from-to)375-383
Number of pages9
JournalInternational Journal for Quality in Health Care
Issue number4
StatePublished - Aug 2011
Externally publishedYes


  • Armed conflict
  • Evaluation
  • Function impairment
  • Indonesia
  • Measurement
  • Psy chosocial
  • Violence

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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